SceneSize-up CHAPTER 8

The first step in any patient evaluation is scene size-up!

Chaos is common at an emergency scene…

...the EMS provider needs to firmly take charge of the incident!

Scene Size-up  Check SCENE SAFETY.  Determine mechanism of injury or nature of illness.  Find out the number of patients involved.  Determine the need for additional help.

Size up the scene as you approach.

Glass and torn metal can present safety hazards at automobile crashes.

A fuel spill can result in a fire or explosion.

Violent scenes can be especially dangerous.

An unstable vehicle may present a hazard.

Body Substance Isolation Precautions

BSI precautions protect against contact with body substances.

Scene Safety

 Personal protection  Protection of the patient  Protection of bystanders

You must first ensure YOUR OWN SAFETY!

Wear protective clothing at hazardous scenes.

If the scene is not safe, and you cannot make it safe… STAY OUT!

Nature of Illness and Mechanism of Injury Nature of Illness

Nature of illness: The patient’s description of the chief complaint; or why EMS was called.

Mechanism of injury: The event or forces that caused a patient’s injury.

Question the patient and family for more information.

Trauma Patients

Mechanism of Injury  Motor vehicle crashes  How fast was vehicle traveling?  What did vehicle hit?  How much and damage to vehicle?  Occupants wearing seat belts or helmets?

Mechanism of Injury continued  Falls  How far did patient fall?  What did patient land on?  What part of patient’s body hit first?  Gunshot victims  What kind of weapon was used?

Suspect significant injuries suggested by mechanism.

Patients removed from a fire......may have suffered severe burns and inhalation injuries.

Number of Patients and Need for Additional Help

DO NOT DELAY WHEN REQUESTING ADDITIONAL RESOURCES

Multiple-patient incidents may require additional resources.

SUMMARY Body Substance Isolation Precautions Body Substance Isolation Precautions Scene Safety Scene Safety Nature of Illness and Mechanism of Injury Nature of Illness and Mechanism of Injury Number of Patients and Need for Additional Help Number of Patients and Need for Additional Help